Asset.Lec.

Hiba Muayad Medical Laboratory Techniques

Clinical Biochemistry Stage: second // Lab: 10
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Estimation of serum Bilirubin (total & direct)

Bilirubin:
Is a waste product from the breakdown of red blood cells. It’s ordinarily
processed by the liver. It passes through the liver before being excreted through
stool. Bilirubin is a yellow compound that produces in the normal catabolic
pathway that breaks down of hemoglobin in body. It is the yellowish pigment
responsible for jaundice.

Red blood cells are broken down at the end of their lifespan by the
reticuloendothelial system, mainly in the spleen. The released haemoglobin is
split into globin, which enters the general protein pool, and haem, which is
converted to bilirubin after the removal of iron, which is reused.

A damaged liver can’t properly process bilirubin. This leads to an abnormally

high level of bilirubin in the blood. A high result on the bilirubin test may
indicate that the liver isn’t functioning properly.
 Asset.Lec. Hiba Muayad Medical Laboratory Techniques
Clinical Biochemistry Stage: second // Lab: 10
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Bilirubin metabolism

Types of Bilirubin:

 Indirect (unconjugated) bilirubin: This form of bilirubin does not

dissolve in water (it is insoluble). Indirect bilirubin travels through the
bloodstream to the liver, where it is changed into a soluble form (direct
or conjugated).
 Direct (conjugated) bilirubin: Conjugated with glucoronic acid by means
of Bilirubin-UDP Glucuronosyl Transferase.
 Total bilirubin: sum of the direct and indirect of bilirubin.

Total bilirubin and direct bilirubin levels are measured directly in the blood,
whereas indirect bilirubin level is calculated from the total and direct bilirubin
measurements since ( TB = D + ID )
 Asset.Lec. Hiba Muayad Medical Laboratory Techniques
Clinical Biochemistry Stage: second // Lab: 10
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Normal value:

Total bilirubin are from (0.1 to 1.0) mg/dL

Indirect bilirubin is (0.2 to 0.7) mg/dL
Direct bilirubin is (0.1 to 0.2) mg /dL

If the bilirubin level exceeds 1 mg/dl, the condition is called

hyperbilirubinemia. When the bilirubin level exceeds 2 mg/dl, it diffuses into
tissues producing yellowish discoloration of sclera, conjunctiva, skin and
mucous membrane resulting in jaundice. Icterus is the Greek term for jaundice.

Jaundice:
Jaundice: is the discoloration of skin and sclera of the eye. It occurs because
RBCs are being broken down too fast for the liver to process, because of a
disease in the liver, or because of a bile duct blockage.

The causes of jaundice may be classified as:

 Pre-Hepatic Jaundice
 haemolytic disease

 Hepatic Jaundice
 Cirrhosis of the liver
 Infective Hepatitis
 Neonatal Jaundice

 Post-Hepatic Jaundice
 Cholecystitis.

The causes of low bilirubin:

There are no health conditions that cause low levels of bilirubin. But taking
certain substances can reduce it temporarily.

1. Caffeine
2. Non-steroidal anti-inflammatory drugs (NSAIDs) called salicylates, such
as aspirin .